To compare the cost-effectiveness of recombinant human follicle-stimulating hormone alfa (follitropin alfa, GONAL-f^®) versus other recombinant human follicle-stimulating hormone injections (Jinsaheng^®, Fangleshu^®, and Anxinbao^®) for controlled ovarian stimulation (COS) in infertile women undergoing assisted reproductive technology (ART).

A decision tree model was developed, simulating the treatment pathway of patients undergoing one ART cycle including one fresh embryo transfer cycle and three frozen embryo transfer cycles following a single COS treatment. Clinical parameters were derived from three independent randomized controlled trials and expert interviews. Drug utilization data for cost parameters came from the same trials, while drug prices were sourced from Yaozh.com. Costs of other medical services were obtained from provincial/city medical price lists and expert opinions. The base-case analysis used cumulative live birth rate (CLBR) as the effectiveness measure to calculate the incremental cost-effectiveness ratio (ICER). The robustness of the results was tested through one-way sensitivity analysis and probabilistic sensitivity analysis (PSA).

Although the total cost of the GONAL-f strategy was higher than that of Jinsaheng, Anxinbao, and Fangleshu (incremental cost: ￥1 219.44, ￥643.19, and ￥250.61, respectively), it also yielded higher CLBRs (incremental CLBRs: 3.91%, 3.13%, and 3.84%, respectively). The average cost per live birth was ￥44 238.72 vs ￥44 844.00 (GONAL-f vs Jinsaheng), ￥52 701.11 vs ￥54 096.63 (GONAL-f vs Anxinbao), and ￥44 028.08 vs ￥45 775.20 (GONAL-f vs Fangleshu). The corresponding ICERs were ￥31 174.32, ￥13 795.07, and ￥6 530.83 per additional live birth, respectively. Sensitivity analyses supported the base-case findings. In the PSA, as the willingness-to-pay (WTP) threshold increased to over ￥100 000, the probability of GONAL-f being cost-effective stabilized at approximately 92.9%, 69.9%, and 81.9% compared to Jinsaheng, Anxinbao, and Fangleshu, respectively. At a WTP of ￥35 000, these probabilities were 58.0%, 71.9%, and 77.8%, respectively.

This study indicates that for COS in ART, GONAL-f incurs higher costs but also achieves higher CLBRs compared to Jinsaheng, Anxinbao, and Fangleshu. GONAL-f is the more cost-effective option when the WTP exceeds ￥31 174.32 per additional live birth.